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Thread: Location of positive cores in biopsy.

  1. #11
    Quote Originally Posted by Another View Post
    A couple of comments. Your husband is too young for any of this indicating his future likely includes a higher grade cancer, if not already. Any cancer profile beginning at an early age implies a more aggressive nature and future status. He is no longer a candidate for the garden variety experience of this disease. He's missed that train. If he is using testosterone supplements or boosters I suggest he consult with his doctors about discontinuing it.

    If his PSA was and is continuing on a steady rise (regardless of spiking) he probably has more than G6, especially, if it is showing an increase in velocity. A reliable PSA history and behavior is now your best friend. Fortuantley, mine was an accurate representation of my cancer's progression.

    Does the genomic testing provide a seccond opinion on the Gleason grading? Labs can disagree on this based on their experience.

    Any reputable AS program has rigid standards for confirming and ongoing monitoring including PSA and it's velocity, volume of cancer, MRI's, and additonal biopsies. Make sure your doctor is clear on this and is not just offering the idea of AS as an informal wait and see. Some doctors are not good at advocating PCa risk. Some are.

    Additional risk factors to age are family history, a BMI of overweight or more, and adverse ethnicity. Thay all contribute to assessing the overall risk, not just one favorable biopsy, and I say that because many men struggle to find the cancer and are tempting to dismiss the rsik with negative biopsies. TRUS biopsies have a high false negative. You've dodged that bullet and have your warning flag on the first go around.

    Cancer at the base, which is the top of the prostate just below the seminal vesicles and bladder is at higher risk to move up and out of the prostate. The prostate anatomy is reverse of what we would expect, the apex is the bottom towards the feet, and the base is at the top towards our head and bladder.

    Early detection early treatment is the hallmark of success with this and any cancer. Denial and delay are the two demons of cancer. This cancer is very treatable and survivable if you deal with it. It's not something you want to play chicken with.

    I have had successul treatment and have recovered from the side effects. The risk never goes away. I will be testing for recurrence ongoingly and am preapred for radiation as my back up if required. Once begun it's never over until and if something else overtakes it as a more serious threat to QOL.

    The youger you are the higher the risk, but also the easier the treatment and quicker and more complete the recovery. Early detection is a blessing squandered by many sorry tales usually generated in fear. Fear is not a power position. Responsible healthcare is something you take charge of and pursue with ruthless persistence. It is an aging shift in being that many men struggle with.
    Some of the logic I see used by a lot of men reminds me of Anton Chigur's quote in No Country for Old Men...

    "If the rule you followed brought you to this, of what use was the rule?"

    It's sad to see people in denial especially when basing that denial on bad data. Not singling out the OP's husband I mean across the board.

  2. #12
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    Quote Originally Posted by IceStationZebra View Post
    Some of the logic I see used by a lot of men reminds me of Anton Chigur's quote in No Country for Old Men...

    "If the rule you followed brought you to this, of what use was the rule?"

    It's sad to see people in denial especially when basing that denial on bad data. Not singling out the OP's husband I mean across the board.
    I don’t think we’re in denial at all. We are taking this very seriously and have pretty much been researching non stop since getting the news. But we currently don’t have enough information to make any sort of informed decision. We have had a lot of “what if” and “if this, then that” type conversations but it’s all just speculation at this point.

  3. #13
    Quote Originally Posted by star0210 View Post
    I don’t think we’re in denial at all. We are taking this very seriously and have pretty much been researching non stop since getting the news. But we currently don’t have enough information to make any sort of informed decision. We have had a lot of “what if” and “if this, then that” type conversations but it’s all just speculation at this point.
    Hi, well my comments weren't directed at you, more a commentary on a lot of men's approaches to pca.

    However you stated that your husband wasn't afraid of dying from pca but was more concerned with treating it. Unless I misunderstood what you were saying that's deep denial, maybe depression and naivety. But maybe I misunderstood what you were saying. Pca death isn't a train your husband wants to ride especially when it is avoidable.

    Good luck. This is an aggravating disease.

  4. #14
    Senior User
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    Is the size of the prostate noted on the biopsy report? PSA density is a key number as well.

    The MSKCC nomogram isn't terribly encouraging between the age and 4 positive cores in terms of organ confinement. https://www.mskcc.org/nomograms/prostate/pre_op

    My husband had his prostate removed shortly after his 44th birthday, and we struggled mightily with the treatment decision. We were both terrified of the side effects of surgery - which turned out to be not nearly as bad as the statistics would indicate. Unfortunately, he had some adverse pathology and just started adjuvant radiation 3 months after surgery.

    PM me if you want to talk!
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 5% (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 (3+4) - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -
    Decipher Post RP score: .78, high risk
    6 week PSA = .015 (ultra-sensitive Labcorp)
    12 week PSA = .014
    ART underway (no ADT)

  5. #15
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    Oct 2019
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    Quote Originally Posted by IceStationZebra View Post
    Hi, well my comments weren't directed at you, more a commentary on a lot of men's approaches to pca.

    However you stated that your husband wasn't afraid of dying from pca but was more concerned with treating it. Unless I misunderstood what you were saying that's deep denial, maybe depression and naivety. But maybe I misunderstood what you were saying. Pca death isn't a train your husband wants to ride especially when it is avoidable.

    Good luck. This is an aggravating disease.
    No, You didn’t misunderstand. I just didn’t word it well. Sorry.
    He’s not afraid of dying in the next 5-10 yrs with a low risk non aggressive contained G6. He currently has zero symptoms and zero issues. No ED (someone mentioned testosterone above....no he’s never had any testosterone treatments or supplements), no continence issues, no nothing.
    Yes, waiting to treat is a risk. A gamble. That’s not denial. That’s assessing how much risk you’re willing to accept. We just don’t know yet.

  6. #16
    Quote Originally Posted by star0210 View Post
    No, You didn’t misunderstand. I just didn’t word it well. Sorry.
    He’s not afraid of dying in the next 5-10 yrs with a low risk non aggressive contained G6. He currently has zero symptoms and zero issues. No ED (someone mentioned testosterone above....no he’s never had any testosterone treatments or supplements), no continence issues, no nothing.
    Yes, waiting to treat is a risk. A gamble. That’s not denial. That’s assessing how much risk you’re willing to accept. We just don’t know yet.
    Okay my apologies, I misunderstood. I read it as bravado and stubbornness when you actually meant that his concern wasn't that the pca would result in his death. Two very different things.

    Good luck. My best to you both.

  7. #17
    Experienced User
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    Quote Originally Posted by AceVA View Post
    Is the size of the prostate noted on the biopsy report? PSA density is a key number as well.

    The MSKCC nomogram isn't terribly encouraging between the age and 4 positive cores in terms of organ confinement. https://www.mskcc.org/nomograms/prostate/pre_op

    My husband had his prostate removed shortly after his 44th birthday, and we struggled mightily with the treatment decision. We were both terrified of the side effects of surgery - which turned out to be not nearly as bad as the statistics would indicate. Unfortunately, he had some adverse pathology and just started adjuvant radiation 3 months after surgery.

    PM me if you want to talk!
    I’m sorry to hear of the adverse pathology. That really stinks.
    The size of the prostate is not noted on the pathology report.

  8. #18
    Top User
    Join Date
    Aug 2016
    Posts
    1,944
    star0210,

    Read AceVA's signature closely. Note the large difference between diagnostic values and actual pathology after surgery and subsequent treatment. This disparity between what it appears to be and what it turns out to be is a risk for everyone, but especially for younger men who present early.

    I am not attempting to be gloom and doom, but making clear diagnosing this disease accurately is difficult and not something to depend on.

    There is a sticky above for abbreviations.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    12-08-19 PSA <0.02, Zero Club 3.5 years

  9. #19
    We are hoping the G6 score verifies (as much as it can be with these methods) and the he can do AS. That’s where he is mentally today. He’s not afraid of dying from this, he’s scared of having to treat it. He says he recognizes that he will likely have to have it removed at some point but if he can have a few more years without dealing with the side effects, he’d rather do that. But he’s still researching like crazy. We both are. And we are in no hurry to make a decision although the waiting for more info is so hard. Hubby is a lot more patient than me!
    I can appreciate your husband's thought process at PSA=4.5 / age 51. You can see from my signature how I managed my 4.0 at age 63 (but I was very fit and physically active so thought of my self as "just a little past middle age") when I was so busy sailing our boat and riding my mountain bike throughout the Cascade and Sierra Nevada mountains. I had no time to deal with Prostate Cancer and 4.0 is such a small number (or so I thought at the time!) My long time primary care physician (PCP) was an internist and also had little interest in educating me about PCa.

    The PSA value went up and down over the next two-years and I and my PCP continued to pretend there was no problem. And, I continued to greatly enjoy life while exploring the US West Coast on our boat and bicycling thousands of miles a year. I had retired at age 52 (1999) and was bound and determined to get the most out of life while I was still "young" and physically able. My wife retired in 2013 and she and I then got really serious about exploring on our boat and bicycling all over Southern California. It was very easy to "forget" my rising PSA. During the 2013 - 2017 time frame neither of my new San Diego PCP's thought it necessary to have my PSA tested, despite knowing my PSA history.

    As you can see, it all caught up with me in summer 2018 and I am now waiting on Decipher to tell me if my 8-year roll of the dice (2010/PSA=4.0 to 2018/PSA=9.2) will have long term consequences. I do know that I lived my life to the fullest extent possible during that time and never thought about my cancer that I was allowing to grow. At this point, 14-months post-RP with a slowly rising µPSA, I have no regrets about waiting to treat my PCa at age 71 rather than in my early-60s when prudence would have dictated initial treatment.

    Now that I am over a year beyond surgery and have a pretty good idea about the long term side effects - I've 'gotta tell your husband that I have almost NONE!

    I play competitive pickleball at a high level with "kids" 20-years younger than me for two or three hours every day. I ride my street bicycle long distances at high work rates just as I always did. My erections are not as firm as they were prior to the surgery but they are functional and my wife of 45-years says she has no complaints or concerns. I do suffer very minor bladder leakage when lifting heavy objects or straining my gut while working. But, I don't wear any kind of pad or protection and my underwear stay dry almost all the time.

    At this point - it is almost as if I had never been treated for PCa.

    SO - life will go on after treatment and, most likely, that life will be pretty much the same as you two knew before treatment.

    When to start treatment is a difficult choice and knowing what I know now about the long term side effects of RALP - I probably would have opted for treatment at age 63 rather than 71.

    You are taking the right approach to your husband's PCa condition so keep asking questions and collecting information!
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028
    10/1/19 0.035

    Decipher RP = 0.47 Average Risk

  10. #20
    Ice...I have many of the same thoughts as you. I’m scared there are places where they didn’t find that are going to be higher than a 6. I’m afraid of how much it could get worse if left untreated. I’ve read your previous posts.
    Just look at my signature!

    tumor was 20-times the size TRUS biopsy and 3TmpMRI reported
    tumor was bi-lateral rather than one side as reported by biopsy
    there was extra capsular extension despite MRI saying capsule was intact
    prostate was twice size reported by biopsy and MRI

    Urologist doing biopsy had over 25-years experience and had done "many, many thousands" of similar procedures.

    3TmpMRI was at a state of the art facility and read/interpreted by a radiologist who had worked with my urologist (MO) for "decades" while managing prostate cancer in thousands of cases.

    The only way to really know is get in there and look around (IMHO!)
    Last edited by OldTiredSailor; 10-23-2019 at 09:05 PM.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028
    10/1/19 0.035

    Decipher RP = 0.47 Average Risk

 

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